Abstract
Treatment of anti-tumor necrosis factor-alpha (TNF-α) antibody has been administered to patients with Rheumatoid Arthritis (RA) . Anti-TNF α therapy is effective for most of RA patients, however, joint symptoms last with some cases. In these years, some reports have mentioned that synovectomy is one of the effective methods for such cases. We report that synovectomy was useful for the patient having polyarthralgia despite infliximab treatment, and inflammatory cell infiltration decreased in the synovial tissue compared with the past specimens.
The patient was 50 years old woman who was diagnosed as RA in 1986. She was treated by prednisolone and methotrexate (MTX), and attained remission once. In 2001, however, she was diagnosed as RA due to reappearance of polyarthritis again. She began to take prednisolone at 10mg in a day because she hoped pregnancy. For her symptoms became worse, we performed synovectomy in 2002. After the delivery, she began to take MTX at 8 mg in a week in 2005, and then infliximab therapy was administered to her in 2006. Her CRP (C-reactive protein) level had decreased by this therapy, but joint swelling and tenderness still lasted. Therefore, we performed synovectomy for some joints which had been severely swollen. In the pathological findings of this excised synovial tissue, it was observed that synovia increase and inflammatory cells infiltrate. However, compared with the specimens of synovial tissue excised four years ago, the degree of the cell infiltration decreased. After that synovectomy, her symptoms and DAS28-CRP score improved. Thus, it is supposed that decrease of cell infiltration into synovial tissue is an evidence of inf liximab treatment being effective, and to raise an efficacy of that therapy, synovectomy is one of the useful methods.
